ATI RN
ATI Exit Exam 2024
1. A client is 24 hours postoperative following a right-sided mastectomy. Which of the following interventions should the nurse include in the plan of care?
- A. Place the client in the supine position.
- B. Encourage the client to lift objects with the right arm.
- C. Measure the client's blood pressure on the right arm.
- D. Elevate the client's right arm on a pillow.
Correct answer: D
Rationale: Elevating the client's right arm on a pillow is essential post-mastectomy to reduce swelling and promote circulation. Placing the client in the supine position may not be comfortable or ideal after a mastectomy. Encouraging the client to lift objects with the right arm can strain the surgical site and hinder healing. Measuring the client's blood pressure on the right arm should be avoided to prevent disruption to the area and inaccurate readings.
2. What is the main purpose of a clinical audit?
- A. To measure patient satisfaction
- B. To evaluate the effectiveness of clinical practices
- C. To identify areas for improvement
- D. To standardize patient care protocols
Correct answer: C
Rationale: The main purpose of a clinical audit is to identify areas for improvement in clinical practices. While patient satisfaction might be a component evaluated during an audit, the primary goal is to ensure that care is safe, effective, and patient-centered, rather than solely focusing on satisfaction. Evaluating the effectiveness of clinical practices is a related but more specific goal compared to the broader aim of identifying areas for improvement. Standardizing patient care protocols can be a result of a clinical audit, but it is not the main purpose, which is to pinpoint areas needing enhancement.
3. A nurse is caring for a client who has cirrhosis. Which of the following laboratory values should the nurse expect to be decreased?
- A. Bilirubin.
- B. Albumin.
- C. Ammonia.
- D. Prothrombin time.
Correct answer: B
Rationale: In clients with cirrhosis, albumin levels are typically decreased due to impaired liver function. Bilirubin levels are often increased in cirrhosis due to the liver's inability to process bilirubin efficiently. Ammonia levels may be elevated in cirrhosis due to impaired ammonia metabolism by the liver. Prothrombin time is usually prolonged in cirrhosis because the liver's ability to synthesize clotting factors is impaired.
4. A client is 2 hours postoperative following a cholecystectomy. Which of the following interventions should the nurse implement?
- A. Place the client in a supine position
- B. Administer morphine for pain relief
- C. Apply a warm compress to the incision site
- D. Place a pillow under the client's knees
Correct answer: B
Rationale: Administering morphine for pain relief is crucial for postoperative clients following a cholecystectomy to manage pain effectively. Placing the client in a supine position may not be ideal as it can cause discomfort and hinder breathing. Applying a warm compress to the incision site can increase the risk of infection. Placing a pillow under the client's knees is not a priority intervention compared to pain management.
5. A nurse is caring for a client who has an indwelling urinary catheter and a prescription for a urine specimen for culture and sensitivity. Which of the following actions should the nurse take?
- A. Wipe the area around the needleless port with sterile water
- B. Insert the syringe into the needleless port at a 60-degree angle
- C. Withdraw 3 to 5 ml of urine from the port
- D. Don sterile gloves
Correct answer: C
Rationale: The correct action for the nurse to take is to withdraw 3 to 5 ml of urine from the port for an accurate culture and sensitivity test. Wiping the area around the needleless port with sterile water (Choice A) is not necessary when obtaining a urine specimen. Inserting the syringe into the needleless port at a 60-degree angle (Choice B) is incorrect as it does not align with the correct procedure for obtaining a urine specimen. Donning sterile gloves (Choice D) is a good practice but not the immediate action required for obtaining a urine specimen.
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